Long‐term survival of a patient with refractory advanced adrenocortical carcinoma after combination chemotherapy with paclitaxel and carboplatin plus mitotane

Figures

• 

  Fig. 1. Imaging findings. Enhanced CT showing (a) a retroperitoneal tumor (arrowhead, 95 × 123 × 132 mm) and metastatic liver tumors (circle), and (b) lymphadenopathy of the hilar region of the kidney (arrowhead). (c) Magnetic resonance imaging (T2WI) showing a retroperitoneal tumor (arrowhead) and metastatic liver tumors (circle). (d) 131I‐adsterol scintigraphy showing no signal accumulation in the left adrenal gland (circle). (e) 131I‐MIBG scintigraphy showing no signal accumulation in the retroperitoneal tumor. [Colour figure can be viewed at wileyonlinelibrary.com]

• 

  Fig. 2. Therapeutic schedule and imaging follow‐up. (a, b) Enhanced CT performed at the initial medical examination showing a retroperitoneal tumor measuring 95 × 123 × 132 mm (arrowhead) and metastatic liver tumor (circle). (c, d) Tumor progression in the adrenal and liver lesions (arrowhead and circle) 8 months after mitotane therapy initiation. (e, f) Complete remission was achieved for the liver metastasis (circle). The adrenal tumor shrank, and internal necrosis spread after 9 cycles of the chemotherapy (arrowhead). [Colour figure can be viewed at wileyonlinelibrary.com]

• 

  Fig. 3. Pathological findings. (a–d) Biopsy sample of the adrenal tumor. (a) Tumor cells with monotonous morphology and large, centrally located nuclei and abundant cytoplasm. Focal tumor necrosis was present (hematoxylin and eosin staining). (b) The Ki‐67 labeling index is 30% at the hot spot. (c) Positive expression of steroidogenic factor 1 (hematoxylin and eosin staining, ×100). (d) Positive expression of caveloin‐1 (e). A piece of tissue weighing 968 g. (f) Viable tumor cells with pleomorphic nuclei and eosinophilic cytoplasm with (g) no tumor infiltration of the kidney. (h) The Ki‐67 labeling index decrease to 4% after the TJ‐M therapy. [Colour figure can be viewed at wileyonlinelibrary.com]